The WHO Raises The Alarm On E-Cigarettes

The World Health Organization (WHO) has been actively addressing concerns related to vaping. In a statement, the WHO highlighted several key points regarding e-cigarettes and their impact on one’s health.

E-cigarettes and ENDS

The most common types of are types of e-cigarettes are electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS). These systems work by heating a liquid to create aerosols that are then inhaled by the user. These so-called e-liquids may or may not contain nicotine (but do not contain tobacco), and also typically contain additives, flavors, and chemicals that can be harmful to people’s health.

E-cigarettes are part of broader product categories of ENDS and ENNDS, which include products such as e-cigars and e-pipes.

Aggressive marketing towards youth

WHO is concerned that these products have been allowed on the open market as consumer products and aggressively marketed to young people. Currently, 88 countries have no minimum age at which e-cigarettes can be bought, and 74 countries have no regulations in place for these harmful products.

E-cigarettes target children through social media and influencers, with at least 16,000 attractive flavors. Some of these products use cartoon characters and have sleek designs, appealing to the younger generation, and some even look like toys and games.

This aggressive marketing has resulted in an alarming increase in the use of e-cigarettes among children and young people, with rates exceeding adult use in many countries. Even brief exposure to e-cigarette content on social media is associated with greater intention to use these products, as well as more positive attitudes toward e-cigarettes.

Are e-cigarettes dangerous?

ENDS contain varying amounts of nicotine and harmful emissions.

E-cigarette emissions typically contain nicotine and other toxic substances that are harmful to both users and non-users who are exposed to the aerosols second-hand. Some products claiming to be nicotine-free (ENNDS) have been found to contain nicotine.

Nicotine exposure in pregnant women can adversely affect the development of the fetus. Further, the consumption of nicotine in children and adolescents has negative impacts on brain development, leading to long-term consequences for brain development and potentially leading to learning and anxiety disorders.

Nicotine is highly addictive and harmful to health. Additionally, high-quality epidemiology studies consistently demonstrate that e-cigarette use increases conventional cigarette uptake, particularly among non-smoking youth, by nearly 3 times. Evidence reveals that these products are harmful to health and are not safe. However, it is too early to provide a clear answer on the long-term impact of using them or being exposed to them.

Whilst long-term health effects are not fully known, we do know that they generate toxic substances, some of which are known to cause cancer and some that increase the risk of heart disorders. Electronic delivery systems have also been linked to several physical injuries, including burns from explosions or malfunctions, when the products are not of the expected standard or are tampered with by users.

Accidental exposure of children to ENDS e-liquids poses serious risks, as devices may leak or children may swallow poisonous e-liquids.

Do e-cigarettes (ENDS) cause lung injuries?

There is growing evidence that ENDS could be associated with lung injuries. E-cigarettes have also been linked to an episode of lung injury in the United States of America. This is described by the United States Centers for Disease Control and Prevention (CDC) as e-cigarette or vaping-associated lung injury (EVALI), which led the CDC to activate an emergency investigation into EVALI on 17 September 2019.

The United States Centers for Disease Control and Prevention noted,

“As of 18 February 2020, there have been a total of 2,807 cases of EVALI reported from all 50 states, the District of Columbia, Puerto Rico, and the US Virgin Islands, including 68 deaths confirmed in 29 states and the District of Columbia. While the cause of these deaths has not been conclusively determined, vitamin E acetate (VEA), a common additive in ENDS that contains cannabis (or THC), is thought to have played a significant role in these cases of lung injury.”

Vaping causes similar DNA damage as traditional smoking

Researchers at University College London found that vape users and cigarette smokers had similar changes to the DNA of cells in their mouths, with these changes linked to the future development of lung cancer in smokers. The study, published in Cancer Research, is the first major study to link vapes, also known as e-cigarettes, to an increased risk of cancer, but scientists say further research is required.

Dr. Ian Walker, Cancer Research UK’s executive director of policy, said:

“Decades of research has proven the link between smoking and cancer, and studies have so far shown that e-cigarettes are far less harmful than smoking and can help people quit. This paper does, however, highlight that e-cigarettes are not risk-free, and so we need additional studies to uncover their potential longer-term impacts on human health.”

Are e-cigarettes safer than conventional tobacco cigarettes?

Frankly, the safest approach is to avoid both.

The levels of risk associated with using ENDS or tobacco products are likely to depend on a range of factors, some relating to the products used and some to the individual user. Factors include product type and characteristics, how the products are used, including frequency of use, how the products are manufactured, who is using the product, user behavior – user’s puffing style – and whether product characteristics are manipulated post-sale.

Toxicity is not the only factor in considering the risk to an individual or a population from exposure to ENDS emissions. These factors may include;

• potential for abusing or manipulating the product
• use by children and adolescents who otherwise would not have used cigarettes
• simultaneous use with other tobacco products (dual or poly use)
• children and adolescents going on to use smoked products following experimentation with END

Dual use, which is common, is at least as dangerous and likely more dangerous than smoking conventional cigarettes or using e-cigarettes alone. Further, not all ENDS are the same and the risks to health may differ from one product to another, and from user to user.

What is WHO doing about ENDS?

The WHO regularly monitors and reviews evidence on ENDS and health and offers guidance to governments.

This includes the biennial WHO Report on the Global Tobacco Epidemic, which tracks the status of the tobacco epidemic and interventions to combat it and other relevant resources. 

In addition, the health body stresses that Member States should implement a comprehensive approach to tobacco control which includes;

• raising tobacco excise taxes
• Bans on tobacco advertising, promotions, and sponsorship
• health warnings
• smoke-free areas
• mass-media campaigns
• supporting people to quit with proven tools such as advice from healthcare workers, toll-free quit lines, mobile and digital cessation services, and approved therapies.

Strong, decisive action is needed to prevent the uptake of e-cigarettes based on the growing body of evidence of use by children and adolescents and health harms.

References

Tobacco: E-cigarettes (who.int)

Chiara Herzog, Allison Jones, Iona Evans, Janhavi R. Raut, Michal Zikan, David Cibula, Andrew Wong, Hermann Brenner, Rebecca C. Richmond, Martin Widschwendter; Cigarette smoking and e-cigarette use induce shared DNA methylation changes linked to carcinogenesis. Cancer Res 2024; https://doi.org/10.1158/0008-5472.CAN-23-2957